[–] AncientArachnid 0 points 3 points 3 points (+3|-0) ago (edited ago)
First off -- the number of people who initially actually needed to buy coverage in the exchanges was, relative to the entire US population, fairly small and should have remained so (I'll come back to that in a minute).
The vast majority of people in the US were covered by an employer's plan, Medicare (65+), or Medicaid (very low income, seniors unable to afford Medicare's small premiums, or those with dependent children).
Obamacare was intended to ensure that people who were not covered by an employer and who did not qualify for Medicare or Medicaid would at least have a hope of a prayer of a chance to access a doctor if they needed one. That imo as a civilized nation is not a bad thing.
The biggest problem was not the individual mandate, although that got a lot of attention (and rightfully so). The biggest problem was the employer mandate that employers with 50 or more employees were required to offer "adequate" coverage to their employees.
What this did was skew and warp our entire employment market, made even worse by the worst recession since the Great Depression. If you were a small business owner, you did everything in your power to cap at 49 employees. People who formerly held 40-hour-a-week jobs were made independent contractors; people's hours were cut to part-time; full-time jobs were cut in two to make two 20-hour-a-week jobs to prevent having to offer insurance. The "gig economy" was already well on its way before the ACA was passed, but the ACA dramatically accelerated it.
So now, all those folks who had been covered by employers, or who might have been able to find full-time benefited work, no longer could and they were forced onto the exchanges, swelling the numbers of those who originally truly needed some way of accessing health care.
Understandably many younger people opted not to buy. This skewed the pool toward older and sicker people, which in turn raises costs, which in turn raises rates => "death spiral". In the meantime, legitimately self-employed people who had been purchasing decent single coverage on the private market saw premiums rise dramatically and unaffordably.
The core issue is not health insurance, coverage, premiums or anything else. The core issue is costs. Health insurance should be available at a reasonable cost for catastrophic events. That's what insurance is.
Health care should be something for which most normal people can pay for the basics themselves. When the cost of simply seeing a doctor for strep throat, a few stitches for a cut, having a mole removed, etc. becomes stratospheric, then people can't take care of even the basic needs themselves. That, though, is a different discussion for a different thread.
Tl;dr: way more people ended up "needing" Obamacare because of how Obamacare twisted the employment market. Catch-22.
[–] VIP740 0 points 6 points 6 points (+6|-0) ago
This is a big issue and the way it's dealt with is important. Simply repealing Obamacare would hurt people, but things would be no worse than they were before it was passed. Obamacare was not a sensible solution, and it still isn't. Here are some things to keep in mind.
While a record number of people have health insurance now, the quality of their insurance is undesirable. With people being coerced to buy insurance if they don't want to be fined, the the government is helping the insurance companies get business they haven't earned. The market has been established in a way that doesn't encourage competition, and is unsustainable in the long run. I myself have gone without insurance, because what would be worth having is too expensive, and what is affordable isn't worth having.
Health insurance is not healthcare. The insurance industry has had a bad influence on the healthcare industry. What most people seem to want, and what the politicians are leading them to believe they'll deliver, is unrealistic. Focus has been shifted from making sure people get healthcare (medicine, surgeries, therapy, etc...), to making sure people demand health insurance (what should only be a safety net to cover payments in extraordinary circumstances). Personally, I think the healthcare in this country should be run in such a way as to make insurance unnecessary for emergency situations (forcing people to pay taxes to be spent on treating the poor, rather than forcing people to pay private companies).
Unfortunately, neither Trump nor Clinton were offering sensible solutions to healthcare during the election.
[–] Kek_is_with_you 0 points 7 points 7 points (+7|-0) ago
From what I've understood, that 20 million is bullshit. Yes, 20 million will lose single payer coverage but that group usually qualifies for Medicare. So in essence, nobody is loosing insurance, it's a scare tactic.
[–] VaingloriousDrivel 0 points 9 points 9 points (+9|-0) ago
Any form of universal healthcare is bad, as it will inevitably lead to the state mandating what you must do and cannot do with your body. Mandating medical interventions is deeply tyrannical.
I take the view that more healthcare and easier access to it is actually bad. Modern medicine, outside a few areas like trauma, is generally more dangerous than helpful. Much of it is chemical warfare on the mind and body. Healthcare begets more healthcare in a vicious downward spiral.
The large detrimental impact of modern medicine on our society is an important redpill that I think few have swallowed, even here. The "humanitarian" and "apolitical" branding of medicine makes its crimes and impact hard to confront.
[–] 3ducks0stones ago
Can't remember where i read it but I've seen studies comparing people that go to the doctor for every little thing, and the people who don't. The don't people live longer, and stay healthier largely.
[–] HuggableBear 0 points 9 points 9 points (+9|-0) ago
The alternative is detaching health care from health insurance. Universal health insurance is not a bad thing and should probably be something we look at. Getting in a car wreck shouldn't ruin you financially for the rest of your life.
Health care, on the other hand, is just a normal part of life. Expecting someone else to pay for your health care is literally no different than expecting someone to buy you a car or a house or clothes or food.
[–] AncientArachnid 0 points 6 points 6 points (+6|-0) ago
Agreed in principle. But what happens if a loaf of bread costs $35? A steak $300? Rent on a trashy apartment $50,000 per month? There's a huge problem when normal, working people cannot buy something they need on a decent salary because the cost of that thing is simply too high.
Reducing cost drastically is the core issue.
30 years ago I paid $45 for an annual wellness exam, somewhere between $5 and $50 for a couple of routine tests, and maybe $15-$20 for a prescription. I paid for that myself. I made $17,500 a year back then, too, so maybe I paid it over two months' time. Fine.
Today the same might be charged out at $600-$1000, depending on how the tests were "coded" and what the prescriptions were. That's complete and total bullshit. The last car I bought didn't cost six times what my very first one did!
Costs are the core issue imo. The American people and American economy are being massively ripped off. But that's a rant for another day.
[–] Malthrax 0 points 3 points 3 points (+3|-0) ago
One possible solution is to lower the financial barrier for smart people to enter into medicine as a career. Costs are high because there ISN'T an over-abundance of doctors. Costs are high because medical school is expensive as fuck. Costs are high because doctors don't have to compete with one another in the "free market". Nobody does comparison shopping based on cost when picking a doctor for routine stuff.
You need enough doctors and nurses that everyone who needs one can get one easily, but not so many that its impossible for those doctors and nurses to earn a living (and pay back their student loans).
[–] Demwitsarestupid 0 points 10 points 10 points (+10|-0) ago
Are you aware that the USA didn't have obamacare from 1776 until 2010? Are you aware that obamacare totally fucked up the greatest healthcare system in the world for no good reason? Are you old enough to remember Demwits crying back in 07 and 08 about the 40 million poor working people who couldn't afford health insurance so they passed a law requiring those 40 million who couldn't afford insurance to buy insurance? Are you gullible enough to believe what the media and Demwits tell you?
[–] [deleted] 0 points 3 points 3 points (+3|-0) ago
[–] Demwitsarestupid 0 points 2 points 2 points (+2|-0) ago
Because Democrats are liars. If in 2008 there had really been tens of millions of working people who couldn't afford healthcare (there weren't), the Dems could have just expanded medicaid and left everything else alone - problem solved. The Democrats never gave a shit who had health insurance and who didn't. The purpose of obamacare was to give the bureaucracy control over 1/5 of the economy and to control the citizenry. The lying Demwits and their conspirators in the media always scream and tear out their hair like this every time Republicans are about to pass any law.
[–] Spez_sucks_cock 0 points 3 points 3 points (+3|-0) ago
I thought the law that prevent interstate competition also played a part into this
[–] Demwitsarestupid 0 points 2 points 2 points (+2|-0) ago
Yeah, that's just typical Democrat regulation that makes things worse just like all Dem regulation.
[–] [deleted] 0 points 11 points 11 points (+11|-0) ago
[–] CujoQuarrel 0 points 2 points 2 points (+2|-0) ago
If I had stayed with O'care my monthly payment this year would have been $1400.
[–] BlancoCanyon 0 points 6 points 6 points (+6|-0) ago
I also think that there is another type of false argument going on. I don't know where the line should be drawn, but keeping everyone healthy is a losing proposition.
It's easy to believe that everyone should have "health care", but there is still always a line drawn. At some point, this treatment or that drug will be not be covered.
[–] 3ducks0stones 0 points 1 point 1 point (+1|-0) ago
No such thing as 100% in the real world.
[–] Planet_Terror 0 points 1 point 1 point (+1|-0) ago
I used to work in health-care field, specifically insurance.
The ACA was offered (voluntold) that all people would need to have insurance or pay a fine (tax). The first year I believe the tax was $95 per person, it went up over the years and I think last year it was 2.5% of your total household adjusted gross income, or $695 per adult and $347.50 per child, to a maximum of $2,085 Some people qualify for exemptions under certain circumstances (income being the big one) and do not have to pay the tax.
You said in your post you are 21, I'm assuming you are healthy and probably just go to the doctor for regular check-ups, nothing serious. Insurance generally is all deductible driven (similar to car insurance). You pay the first $X,XXX.XX dollars (typically about $1,500) PLUS your monthly premium and then when you meet the deductible you typically pay 20% of the bill after the deductible is met up to your out of pocket maximum, if you have a max otherwise you keep paying the 20% until your policy renews and then you start all over again. The catch is your doctor needs to be in network otherwise you will pay a lot more because your out of network doctor does not have a contract with your insurance company and can basically charge whatever they see fit.
The reason The ACA failed is most healthy people would rather pay $695 tax and get a regular check-up for about $100 one time a year than pay a monthly premium PLUS deductible and out of pocket maximum considering the costs is probably lower. (I've seen deductibles as high at $10k a year for a certain popular retailer and you know those employees do not make enough to cover that deductible). The tax I would imagine is the lesser of the two choices depending on the coverage you choose via ACA.
So while it was great that everyone could sign up for and have insurance, the only people who did were those who were already sick. That placed the insurance companies in a precarious position as they were loosing money (greedy bastards). They thought that the cost of the insurance for the sick people would be offset by the healthy people signing up who would not use the plan but still pay the premiums.
I'm not a proponent of entitled health-care for everyone, what I am for and what should be done is to regulate the costs of health-care procedures. You can call your insurance company and they can give you an estimate of what a procedure will cost with an in network doctor but it all depends on your doctor and what price they negotiated with the insurance company for each procedure and typically it can be different for each doctor sometimes by thousands of dollars. There needs to be more transparency on the actual cost not the wait and see what I'm being billed approach (hospital stays are a fucking nightmare where billing is concerned).
I also believe that me being older and unable to have kids, not having gender re-assignment surgery or will never need fertility treatments should not have to pay for these services in my premiums but that's a different topic.
To give you an example, I had gamma knife surgery last year when all the bills came in the total racked up was over $100k. It was great that I had insurance and my max out of pocket was $5k due to employer sponsored coverage. However, for the time that surgery took (it was an out patient procedure)3.5 hours for prep and waiting and maybe 30 minutes for the actual radiation treatment, it should never have been that much money. If I did not have insurance I would have been fucked..... Again, I strongly believe we need to regulate the prices and not make everyone have insurance.
I'm now in HR and it is an absolute headache to process the forms for all employees not to mention the calculation to figure out if an employee should be offered coverage if they don't work XX amount of hours... again another topic.
TLDR: Mandatory insurance is not the answer, regulating pricing on procedures, office visits, and medication is what is needed.
[–] Malthrax 0 points 1 point 1 point (+1|-0) ago
I agree with most everything you said, except "regulating pricing on procedures ..." because government price-fixing DOES NOT WORK, because the people who would be setting those prices are too easily influenced by lobbyists.
[–] Planet_Terror ago
Thanks, I should have been more clear on the definition of regulating but my post was already long. I agree the government should be left out of regulating the prices with those damn lobbyists. One idea is the insurance companies can definitely provide an average of costs for each procedure as we already know it's different from doctor to doctor and state to state. That could be used to set pricing. Perhaps have a percentage increase every 3-5 years or so so long as incomes do not remain stagnant.
[–] AncientArachnid 0 points 1 point 1 point (+1|-0) ago
Industry lobbyists are a big part of the reason prices are so high now.
What do we do? Serious question.
[–] AncientArachnid 0 points 1 point 1 point (+1|-0) ago
Excellent comment, thank you.